I often think about dopamine as
the three Ms
so kind of movement
which we know about
motivation and mood
If you're a bit sort of overcooked on dopamine
then you tend to have uncontrollable movement
kind of mood can be highly variable
and the sort of motivation can, in some people can be a bit
impulsive, compulsive and energised if you like
and the flip side obviously the opposite of that is then
the kind of sort of stiffness, rigidity
the kind of low mood
and the kind of loss of motivation
and there's obviously a bit, a little bit of dyskinesia
Yeah I mean the other night I was trying to eat my food
and I couldn't get this hand, it just wouldn't come up and
I was having to lean all the way down to have my food
Is that, is that when your meds wear off a bit?
I think when I'm sort of quiet
you know when I'm moving around it's less
obviously it's less noticeable but even just sort of
when I, almost like the more I think about it the worse it gets
I haven't felt like myself
And then we need to think about the sort of DBS
side of things don't we
For most patients with Parkinson's that little
green area is a subthalamic nucleus
That's the field that sort of brown ball
that's kind of buried in it so that targeting is really good
and that's providing good symptom control
and so you can see what you want to do is target this
as carefully as possible with your electrodes
and then you will set up your stimulating field
to try and target this area and avoid these others
The reason why it's a little bit easier to do it under anaesthetic
and with coordinates is because actually
then you can pull that field into an oval
you can push it more left and right
front or back
So obviously when we talked about DBS before
and referring you up, you were a bit
I think kind of knocked for six
I suppose that I'd even discussed it as an option
What knocked you for six about that discussion?
I've had an about face because
initially when we talked about it on the very first
sort of meeting that we had
and we came out, Richie was saying
isn't that amazing that they've got this thing
and I said are you kidding me
you know I have trust issues you know
I don't know whether or not I'd trust people with
scissors on my hair let alone with a
you know, do you know what I mean
I'm the sort of person who checks inside my sandwiches
I am, you know who's gonna
so the idea
so say to somebody yeah knock yourself out
you know just poke about and
stick some wires in I was thinking
Whereas now I'm thinking I would bite their ankles off
in order to have it because
for me it equals getting better or as better as I can be
I spend such a lot of time with people
who are constantly telling me that you can't tell
that I've got Parkinson's
For it to feel that I would be a candidate for it was
almost, it's validating
that I've got Parkinson's but it doesn't fit in with the
mirror that's being held up to me on a
Monday to Friday 9 to 5, does that make sense?
That makes sense yeah
I mean there are lots of different reasons
why you might think of somebody
as a good candidate for deep brain stimulation
so sometimes it's a tremor thing
and we know that that's a difficult symptom
sometimes it's this sort of roller coaster
as somebody was saying to me earlier today
this kind of motor fluctuation
where they're on they're off they're on they're off
and their tablets work for them but not for long
or they're very sort of wriggly and dyskinetic
when they're on and so you don't really get that
you don't get much good on time for a person
and that roller coaster
that sort of person can respond quite well to DBS
and then the other thing is the sort of dystonia
which is quite common in Parkinson's but not
normally quite as bad as yours
that seems to me to be a good target
surgically as well
I guess you have to just have a realistic expectation
of what the surgery does don't you
It helps with your extremities almost but not the core stuff
so it's not going to help me with fatigue or
those sorts of
you know wouldn't help with my memory
but it might help me with my dyst-
you know with the dystonia shizzle that happens
on the feet and hands
Definitely kind of reduces muscle stiffness, dystonia
posturing, discomfort
can be useful for pain, for tremor
you know you have to sort of like I said
it's different for everybody
I think the other nice thing about the DBS is that it
theoretically anyway is functioning 24 hours a day
which means your first bit of the day
where you might be under medicated
your overnight, which can be tricky
you know it has a role for that as well
It takes quite a lot of fine tuning
and I would usually say to people it will take about
6 to 12 months after surgery
to get to that sort of point of equilibrium
where your symptom controls are optimal
Archie you are living legend